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CSI > Philip Craven - Breathlessness > Flashcards

Philip Craven - Breathlessness Flashcards

1
Q

What are the RESPIRATORY differential diagnoses for shortness of breath?

A
  • Asthma
    - COPD
    - Pulmonary fibrosis
  • Lung cancer
  • Pulmonary embolism
  • Pneumothorax
  • Lower respiratory tract infection
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2
Q

What are the CARDIOVASCULAR differential diagnoses for shortness of breath?

A
  • Congestive heart failure
  • Heart attack
    - Pulmonary oedema
    - Valvular defects
    - Acute coronary syndrome
    - Anaemia
    - Renal or liver failure
    - Deconditioning - becoming unfit
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3
Q

What are PSYCHIATRIC differential diagnoses for shortness of breath?

A
  • Anxiety
  • Panic attacks
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4
Q

What are more SYSTEMIC differential diagnoses for shortness of breath?

A
  • Being unfit
  • Being an unhealthy weight (can lead to obesity hypoventilation syndrome if weight extreme)
  • Smoking
  • Muscular diseases eg. muscular dystrophy
  • Postural conditions - kyphosis, scoliosis
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5
Q

What are the steps a doctor may take when a patient complains of breathlessness?

A
  • Use the MRC breathlessness scale
  • Ask questions about breathlessness
  • Do some tests to help diagnose what is causing breathlessness
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6
Q

What is the MRC breathlessness scale?

A

Medical research council scale that shows what your breathlessness stops you doing and gives you a grade that describes you when you are at your best

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7
Q

What are some open questions that doctors may ask patients about breathlessness?

A

SOCRATES and family, drug and social history and ICE

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8
Q

What tests might doctors do to help diagnose the cause of breathlessness

A
  • Use spirometer
  • Respiration rate
  • Chest X-ray
    -ECG
  • Echocardiagram
  • Chest auscultation
  • BP and temp
  • Blood test
  • Psych questionnaire
    etc.
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9
Q

What are some closed questions that doctors may ask patients about breathlessness?

A
  • Is he waking up at night? (heart failure makes lying down worse due to fluid buildup)
  • Chest pain
  • Cough
  • Colour of sputum (yellow/green - infection , pink + frothy - heart failure)
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10
Q

What is FVC?

A

FORCED VITAL CAPACITY
- Amount of air that can be forcibly exhaled from your lungs after taking the deepest breath possible

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11
Q

What is FEV1?

A

FORCED EXPIRATORY VOLUME IN 1 SECOND
- Maximum amount of air that the subject can forcibly expel during the first- second following maximal inhalation.

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12
Q

What is a normal FEV1/FVC ratio?

A

70-80%

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13
Q

Will FEV1 be higher lower or normal with restrictive lung diseases?

A

Normal if airways unaffected

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14
Q

Will FVC be higher lower or normal with restrictive lung diseases?

A

Lower as lung capacity is restricted

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15
Q

Will FEV1 be higher lower or normal with obstructive lung diseases?

A

Lower as air cannot be expelled quickly enough

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16
Q

Will FVC be higher lower or normal with obstructive lung diseases?

A

Normal even though airways are tighter they can get a normal amount of air in and out, just in a longer time frame

17
Q

What are the possible causes of restrictive lung diseases?

A
  • Scoliosis
  • Interstitial lung disease
  • Muscular dystrophy
  • Obesity
  • Sarcoidosis
18
Q

What are the possible causes of obstructive lung diseases?

A
  • COPD
  • asthma
  • bronchiectasis
  • cystic fibrosis
19
Q

What results are needed to confirm restrictive lung disease?

A
  • FEV1/FVC ratio is normal/slightly higher
  • FVC is lower
20
Q

What results are needed to confirm obstructive lung disease?

A
  • FEV1/FVC ratio IS LESS THAN 70% of predicted value
  • FEV1 is less that 80% of predicted value
21
Q

What is the pathophysiology of bronchitis?

A
  • Chronic inflammation
  • Caused by infection (normally)
  • Mucuous gland hypertrophy
  • Increase in goblet cells
  • Narrower lumen
  • Overproduction of mucus
  • Phlegm cough (3 montyhs for 2 consectuctive years)
22
Q

What is the pathophysiology of emphysema?

A
  • Chronic inflammation
  • Interconnections between alveoli gets broken down and results in increased sacs so smaller SA:V ratio therefore less efficient gas exchange
  • No elastic recoil
  • Hyperinflation
23
Q

What are the signs on MrCraven’s xray indicating his emphysema?

A
  • smaller + narrower heart
  • Smaller diaphragm
  • Gastric bubble
  • Hyperexpansion
24
Q

What are the signs of hyperinflation?

A
  • More than 7 anterior ribs
  • Flattening of the diaphragm
  • Heart is small and narrow
25
Q

What are some factors that help COPD?

A
  • Smoking cessation
  • Maintaining a healthy weight
  • Keeping warm
  • Good nutrition
  • Pulmonary rehab programme
26
Q

Name the types inhaled medications for COPD

A

Bronchodilator rescue therapy
- Beta -2- agonists and muscarinic antagonists
Inhaled corticosteroids

27
Q

How do beta 2 agonists work?

A
  • They interact with B2 receptors to activate coupling of G protein adenylcyclase.
  • This leads to more cAMP –> pKA and this results in smooth mucle relaxation.
28
Q

How do muscarinic antagonists work?

A

They block M3 receptors to prevent binding of Ach, indirectly stimulating smooth muscle relaxation via inhibition of bronchoconstriction.

29
Q

How do inhaled corticosteroids work?

A

Anti inflammatory for airways

30
Q

How are inhaled corticosteroids used?

A

NOT ALONE!
Numerous different drug combindations exist within a single inhaler - eg in combination with a long acting beta agonist

31
Q

What are the treatments involved with smoking cessation?

A
  • Abrupt quitting with a combination of drug treatment and behavioural support (NHS Stop Smoking Services)
  • Nicotine replacement therapy, varenicline and bupropion hydrochloride
32
Q

What is the most effective drug treatment for smoking cessation?

A
  • Varenicline
  • Long acting NRT and short acting NRT
33
Q

How does NRT work?

A

Replaces nicotine and helps with unpleasant withdrawal symptoms

34
Q

How does varenicline work?

A

Reduces cravings
Blocks the rewarding and reinforcing effects of smoking

35
Q

How does bupropion hydrochloride work?

A

Has an affect on the parts of brain involved in addictive behaviours

CSI (11 decks)

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